Generation Y and the HIV-AIDS response in Asia-Pacific

The slogan says it all - "I didn't choose to be gay, I just got lucky."

It captures the optimism, exuberance and perhaps even arrogance of youth - qualities that may be needed, as gay youth in the region face the challenge of staying safe in the face of a health threat, for which there is as yet no cure.

It's the generation of Beyonce and Lady Gaga, of smart phones and social media - in short, it's the region's Gen Y and their slightly older brothers and sisters (but mainly brothers).

Men who have sex with men have been identified by the UN as a key at-risk group in Asia and the Pacific - particularly in urban areas.

For all the gains made, new HIV infections reduced by over 50 per cent in some countries, the regional annual numbers have changed little over the past five years.

And while national HIV prevalence levels are low among the general population, some key populations are not doing so well.

HIV rates have actually risen in six countries - China, Indonesia, Malaysia, Myanmar, Thailand and Vietnam - and particularly high in the cities of Bangkok, Hanoi and Jakarta.

People who inject drugs are at risk, as are female sex workers and men who have sex with men (MSM), including the gay youths of Southeast Asian cities.

APCOM is a regional coalition on male sexual health. It had a significant presence at ICAAP11 (International Congress on AIDS in Asia and the Pacific) in Bangkok.

APCOME is known for its youth advocacy work and its executive director is the man with the impossibly romantic name, Midnight Poonkasetwattana.

Midnight met me for twenty minutes, in between sessions at the Queen Sirikit National Convention Centre. The Thai-born director of APCOM is familiar with Bangkok's gay scene, especially the young people who populate it.

He told me that the rate of HIV infection in Bangkok is 25 per cent, including many young gay males who don't seem to be getting the safe sex message.

"Thai society may be open in terms of sexual diversity, but when it comes to supportive laws and policies, that's totally different," he said.

"Transgender people within Thailand cannot have their identity as female, like they want to be.

"And for gay men who have sex with men, they're still expected to have a family and raise a family."

Midnight Poonkasetwattana laments the current lack of government leadership in Thailand, pointing to the successful sex worker program of the 1990s, which achieved 100 per cent condom use.

So why is the safe sex message not getting through to young gay men, with all the information available today?

American gay men remember the Reagan administration for the initial silence surrounding HIV-AIDS, followed by a cynical and some say heartless attitude towards HIV-AIDS in the 1980s.

'Reagan red' was a signature colour of the First Lady, Nancy Reagan, who favoured the colour in her Adolfo suits. Reagan red also became a steely Stop Sign metaphor for her 'Just Say No' campaign against drugs. It was a slogan many gay men in the 1980s adopted as a mantra to unsafe sex.

So why aren't the young men of Bangkok being just as sensible?

Midnight Poonkasetwattana shot me an incredulous - albeit polite - look as if to say, it doesn't quite work that way.

"It's easy to say," he smiles.

"But sex happens in so many different ways, and it's different for different people. So many various ways of negotiation. It's not working just to say condoms alone - so the message is not you have to use condoms all the time - it's about knowing your status, how to protect yourself and also your partner."

"It's actually about people not testing, people who don't know their status and still going out there having risky sex."

Former Australian High Court judge Michael Kirby is a commissioner of the UNAIDS Lancet Global Commission on the Future of Public Health.

I had a brief post-breakfast chat with him at the UNAIDS meeting in Bangkok.

Sex happens in so many different ways, and it's different for different people. It's not working just to say condoms alone - so the message is not you have to use condoms all the time - it's about knowing your status, how to protect yourself and also your partner.

Mr Kirby is uncompromising in his view that applying criminal law to HIV non-disclosure does not work.

"I can understand that society takes a view that a person who infects another with HIV is doing a very wrong thing, if they know their HIV status," he said.

"But one of the problems of criminalising, is that it gives a discouragement to people to find their HIV status.

"The best defence against the law, which imposes a criminal sanction on infecting another, is not to know your HIV status .. if you criminalise it, well, it's better not to know."

And the law is but one layer of the HIV-AIDS story.

Discrimination and stigma discourage many people from taking the HIV test. Even being seen around a testing centre may be socially incriminating in many Asia-Pacific communities.

Then there's legal reform; many countries still criminalise sex work and homosexuality between consenting adult men.

Fiji surprised many in 2010, when the government issued a decree which decriminalised sexual activity between consenting adult men.

The fast approaching deadline of the 2015 Millennium Development Goals has lent some urgency to issues of advocacy, health and development. And HIV-AIDS is no exception.

In an age when so many promising medical advances have been made, including the anti-retroviral cocktail of drugs which can help keep HIV-positive people live longer and fuller lives, governments are in danger of being lulled into complacency.

The one message I took away from ICAAP11 was that HIV-AIDS in the Asia-Pacific region was at a pivotal point - that if regional governments did not act immediately, with sustained and concentrated financial and other investments in HIV care and fighting transmission, the momentum gained thus far might be lost forever.

And that will be devastating for an entire generation of potentially productive young men who are needed to help their countries embrace the opportunities presented by this 'Asian Century'.